GP partner and PCN leader Dr Helen Maxwell-Jones and team explain the benefits and practicalities of employing a pharmacy technician in general practice.
The role of the Pharmacy Technician (PT) is complex and diverse.
A PT working in general practice will assist with strategic and operational planning of medicines and chronic disease management based services, and support pharmaceutical care of patients by working with the pharmacy team to deal with medication issues, such as identifying discrepancies in medication histories and ensuring drug monitoring is actively managed. They contribute to processes that help to maximize benefit and minimise risk to patients from their medicines, and ensure the smooth transition between primary and secondary care.
More specifically, the PT can:
The role of the PT can also be expanded with supervision, time and protocols to include chronic disease management, immunisations and phlebotomy.
Through the above activities a PT will take on some tasks usually undertaken by GPs, therefore reducing non-clinical and clinical workload for GP staff and freeing up their time.
The main difference between a PT and a pharmacist is that a pharmacist can become an independent prescriber, whereas a PT cannot be trained for this. However, in our case we haven’t found this to be limiting. Pharmacists can also conduct care home medication reviews. Again, in our case we have been able to access a CCG pharmacist for this purpose in joint ward rounds.
The role requires an experienced PT, with a pleasant manner and an ability to work in a diverse clinical and non-clinical team. The PT will work across different teams and therefore must be adaptable.
They will need qualifications such as the City and Guilds Level 3 NVQ Diplomas in Pharmacy Services Skills and Pharmaceutical Science. We have also found it advantageous for the PT to have a good knowledge of secondary care medicine, especially from working on wards and with experience of handling discharge summaries. A ward-based medication management technician with ample face-to-face patient experience is the closest secondary care role to that of the PT in primary care, in our experience. This is due to their experience in transcribing discharge summaries and clinic letters, and their knowledge of the shared care pathways meaning they are used to dealing with such drugs, as well their ability to navigate the hospital systems.
As outlined above the scope of a PT’s role is wide and comprehensive. The job is a patient facing role and therefore a good manner is essential. PTs are vital in improving patient compliance and therefore good consulting skills are essential. With the ever-evolving face of primary care a PT needs to be adaptable and forward thinking.
Practices should expect to pay a PT at Agenda for Change (AfC) Band 6-7 in line with their experience and responsibilities (see 2020/21 AfC Annual Tariffs).
However, practices are currently faced with a choice to recruit a PT themselves or access a PT through the Primary Care Network (PCN) DES Additional Roles Reimbursement Scheme (ARRS). The latter for this current financial year was expected to be one WTE reimbursed for the whole PCN but with Covid-19 conditions this year delaying roll out, CCGs are being flexible in ARRS spend and certainly it is expected that more PTs will be covered by the scheme in the next financial year as part of the drive to create a medicines management primary care workforce.
As with most ARRS roles, the maximum reimbursement rarely covers salary plus associate employment costs or ‘on-costs’. Adequately experienced PTs will usually be recruited from ward-based medicines management roles or CCG medicines optimisation teams and this raises recruitment issues with the move to hire staff in general practice roles at scale. The pool for recruitment is therefore limited and starting salaries are likely to be at the higher end of band 6 for retention purposes.
There are a number of potential benefits. PTs reduce the clinical load for GPs by carrying out medication reviews, while their expertise in the specific drugs also improves patient safety.
Having a dedicated PT also helps with monitoring and addressing issues with poor adherence to medications, as well as overuse or over-demand for medications, and gives another layer of risk assessment and response.
Through all this they can significantly reduce day-to-day workload for GPs.
They can also increase practice income, by improving QOF compliance and flu vaccination uptake as well as being a potentially more cost-effective role than more traditional staff.
Taking on a PT will require dedicated GP time to develop protocols and processes for the PT to work within, but once done the effort and time is rewarded. The role also requires some ongoing GP supervision. Overall, as with any new role, the time invested tends to correlate with the benefits seen.
Case study: How our pharmacy technician is improving patient care while freeing up GP time
Practice setting
We are a rural practice with a population of in excess of 8,000 patients. It is a mainly white and middle-class affluent population, but with pockets of deprivation.
Why we hired a pharmacy technician
We took on our pharmacy technician (PT) to replace a pharmacist we had employed on a CCG pilot. We used the knowledge gained from the pilot to reassess our needs and the possible scope for this new role. We were aware that GP time was being used for various tasks outside of their patient facing remit, and wanted to realign with the Tiered Care Model employed in the rest of the practice which dictates that the patient or issue is dealt with by the most appropriate person. We considered that a PT would be able to do a lot of the paperwork that took GPs away from patient facing roles, and also become involved in some of that clinical work if appropriately educated and supervised.
The roles our pharmacy technician fulfils
Our PT carries out all the key core duties outlined above, namely medication reviews and drug monitoring with the appropriate protocols and supervision, as well as dealing with discharge summaries, clinic letters and medication queries.
We have also looked to increase our winter pressures capability by giving the PT planned work to do in the summer months. For example, all our contraceptive pill checks and levothyroxine medication reviews, where clinically appropriate, are done by the PT in the spring and summer months thus reducing demand on our ANP and GPs, and phlebotomy – especially important ahead of the second wave of Covid-19 this year.
In addition, the PT chairs our medicines management meetings, is involved in the Quality and Improvement meetings and maintains the appropriate sections of the Practice Assurance Framework. She also manages the medication related significant events and oversees, maintains and manages the risky medicines and complex medicines register.
Our PT has 20-minute appointments for medication reviews. Whilst doing the reviews she will also do chronic disease management for QOF, check blood pressures and give flu jabs (under a Patient Specific Direction – this is often the case for vaccinations in Primary and Community Care, so integrating the technician into the annual system is straight forward). As she has increased her consultation speed, she uses any additional time to manage the myriad of tasks already outlined. She is by nature of her personality and our expectation of the job role more than able to fill her time constructively, so we have not reduced her appointment times in line with increasing efficiency.
Benefits we have seen
We have found the PT’s activities have had a significant impact on day-to-day workload as well as practice income, with improved QOF prevalence, monitoring and coding. The PT also gives us peace of mind that drug monitoring is appropriately and actively managed.
Although we have not yet collected any data formally, the time saving for GPs is tangible on a daily basis. For example, when reading discharge summaries, the GP only needs to check the drugs are correct rather than transcribing them. The PT has taken over various drug monitoring requirements and shared care over-seeing that a GP once did, completely freeing up the GP for other work. She has also been able to take significant workload off the GP by performing some medication reviews, where appropriate protocols are in place.
In addition, the PT now takes responsibility for liaising with the hospital regarding the vast majority of medication queries.
Challenges
As with any job role, finding a personality that fits with the team and has the appropriate skills and experience was the biggest challenge.
We have had to invest GP time, both initially in setting up protocols and educating the PT, and in the long term in supervising and extending and monitoring the job role. However, the time invested has been well worth it and we and our patients have benefited hugely.
Future development of the role
We plan to increase the PT’s scope to do more complex medication reviews. She has also embarked upon online and face-to-face mental health training, with the aim of being able to safely review SSRIs and recognise when a patient could be referred to a GP to consider reducing and stopping them. We believe that a medication review is only worth doing if it is done actively and not as a ‘tick box exercise’. There are many other reviews and routine work that can be done in the warmer months and we continue to explore this with a view to strengthening our winter resilience.
Dr Helen Maxwell-Jones is a GP at Henmore Health – The Surgery and Clinical Director for the Henmore Group, Sarra Hardy is the Clinical Pharmacy Technician at The Surgery , Samantha Fitchett is the Operations Manager at The Surgery and Danny Smart is the CEO of the Henmore Group.
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